The Women Have Spoken: A Patient-Centered National Survey on Use of Emergent O plus Transfusion

INTRODUCTION: Hemorrhage is the leading cause of preventable death after trauma. Alloimmunization risk and later serious fetal harm from emergency transfusion of O+ blood is estimated at 1% to 6%. Limited availability of O- blood may lead to female lives lost over concern for their future children. We sought to characterize how women in the at-risk population feel about emergency blood use and potential future fetal harm. METHODS: A national survey was performed using Facebook advertisements and Qualtrics XM software in 3 waves from January 2021 to January 2022. Advertisements directed users to the survey site with 7 demographic questions and 4 questions on accepting transfusion with differing probabilities for future fetal harm (none/any/1:100/1:10,000). Transfusion questions were scored on a 3-point Likert scale (likely/neutral/unlikely). Completion was required for analysis. Childbearing age was defined as 15 to 49 years old. RESULTS: The advertisements were viewed 16,600,430 times by 2,169,805 people with 15,396 advertisement clicks and 2,873 surveys initiated. Most (79%; 2,256 of 2,873) were fully completed. The majority (90%; 2,049 of 2,256) of respondents were female. Of females, 80% (1,645 of 2,049) were childbearing age. Most women responded likely or neutral to accept lifesaving transfusion with the following: no risk fetal harm (99%); any risk (83%); 1:100 risk (85%); and 1:10,000 risk (92%). A minority answered unlikely to the same questions: no risk fetal harm (1%); any risk (17%); 1:100 risk (15%); and 1:10,000 risk (9%). The was no difference in females likely to accept lifesaving transfusion with any potential for future fetal harm when stratified by childbearing age (p = 0.24). CONCLUSION: This national survey suggests the majority of women would accept lifesaving transfusion even with potential risk of future fetal harm.